AB1646 GENDER DIFFERENCES OF FRACTURE RISK IN PATIENTS WITH POLYMYALGIA RHEUMATICA
Authors: G. Horton, Z. Sultan, M. Bukhari
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Polymyalgia Rheumatica (PMR) is usually treated with steroids, but long-term usage is detrimental to bone health. It is not uncommon for corticosteroid treatment to last for longer than a year [1]. No study has looked at the differential effect of steroids on either gender in this group of patients. <h3>Objectives</h3> To examine the effect of steroids on bone health in patients with PMR by gender. <h3>Methods</h3> Patients with PMR referred for BMD (Bone Mineral Density) estimation in a district hospital in the northwest of England between 2004 and 2011 were examined. Patients' demographics were recorded and Bone mineral density (BMD) were measured in both hips as well as the lumbar spine. Frax(TM) Risk factors (RF's) for osteoporosis were also ascertained at the time of DEXA. Initially RF's were compared between men and women using a students' T test for continuous variables and chi squared test for categorical variables. A logistic model was then fitted to compare RF's for fracture between men and women. Lastly a stepwise multivariate model was fitted using STATA (tm) version 12. <h3>Results</h3> 1051 patients with PMR were referred in the study period, mean age was 81.74 years (SD 9.58). 764 (84.7%) were females. Fractures were sustained in 26.3 % overall and there was a significant difference in males and females. Females were 2.58 times higher odds to sustain a fracture (CI 1.79 - 3.70). Using univariate logistic regression, the RF's for fracture in men were a reduced lumbar spine BMD (OR.794, CI.657 to.959) and a reduced left femur total BMD (OR.748, CI.568 -.984). In women the RF's were increasing age (OR 1.04, CI 1.020 to 1.055), reduced lumbar spine BMD (OR.841, CI.764 -.926), reduced right femur total BMD (OR.738, CI.644 -.845), reduced left femur total BMD (OR.706, CI.615 -.810) and current steroid therapy (OR.573, CI.369 -.889). In the multivariate model the RF's in men were a diagnosis of coeliac disease (OR 17.38, CI 1.746 - 173.03), and a reduced left femur total BMD (.783, CI.588 - 1.042). In women the RF's were increased age at scan (OR 1.025, CI 1.004 - 1.047), history of fracture (OR 1.891, CI 1.104 - 3.238), reduced left femur total BMD (.720, CI.611 -.849) and reduced BMI (OR 1.035, CI 1.002 - 1.068). Characteristics are shown in Table 1 below. <h3>Conclusion</h3> Men and women with PMR differ in their bone health, firstly in their demographics and secondly in their fracture risk with men who malabsorb having the highest fracture risk. This is the first intimation that fracture risk could be different. Limitations included not knowing the steroids' duration before scanning and only using first scan data. Strengths include the large number of subjects. Longitudinal data the collection of which is ongoing will provide further clarity. <h3>Reference</h3> [1]NICE CKS. CKS is only available in the UK [Internet]. NICE. 2021. Available from: https://cks.nice.org.uk/topics/polymyalgia-rheumatica/ <h3>Disclosure of interest</h3> None declared. <h3>Disclosure of Interests</h3> None Declared.